**1. Introduction**

Diabetes mellitus (DM) is a metabolic disease characterised by elevated blood glucose levels resultant of insufficient production or action of insulin, resulting in Type 1 (T1DM) and Type 2 (T2DM) respectively. Chronic hyperglycaemia is responsible for an array of severe macro- and micro-vascular complications resulting in numerous health complications. These include cardiovascular disease, retinopathy, nephropathy, neuropathy and osteopathy. Globally, more than 450 million adults are living with DM, while the annual death toll of DM is over 4 million people [1]. 70% of recorded deaths where T2DM is a contributing factor are due to T2DM comorbidities rather than T2DM itself, indicating insufficient or ineffective treatment of comorbidities [1, 2]. This statistic emphasises the importance of treating not only T2DM but also the complications associated with it, which are often present despite seemingly effective T2DM management.

The cost of treating T2DM includes the direct management of the disease with medication and medical visits as well as that of treating the associated complications and comorbidities which account for 53% of the total cost of T2DM patient care [3]. This puts the annual global healthcare expenditure on complications alone at \$324 billion as of 2014 [4]. The continued increase in the healthcare budget spending on DM complications tracks the overall increased prevalence of the disease, but is also dependent on the likelihood of those complications within the DM population. Age is positively correlated with both onset of T2DM and its complications [5, 6]. In some middle income countries T2DM per capita is approaching 30% and increasing, these extraordinarily high rates of disease are intersecting with increasing life expectancy, which is also increasing fastest in middle-income countries [7, 8]. This will further compound the prevalence of T2DM complications and the associated morbidity, mortality and financial costs as the duration of disease and the average age of people living with it increases [9].

Despite a slightly increased prevalence of DM in men than women, more women than men die from DM and its associated complications [1]. Here we discuss the contribution of gender as a variable in the development of T2DM, its associated comorbidities and resulting mortality rates.
